HAR §17-1737-78. Hearing evaluations and devices

(a) All hearing aid rentals, purchases, or repairs shall require medical approval by the department. (b) Persons requesting hearing aids shall have a hearing evaluation by a physician who is an ear, nose, and throat specialist who concurs with the need for a hearing aid. (c) The following conditions and limitations shall apply: (1) A hearing evaluation may be permissible every twelve months; (2) Hearing aids purchased by the medicaid program shall be of the unilateral type. Miniaturized or "all in the ear" hearing aids are excluded. Special models or modifications shall require justification with documentation of medical necessity; (3) Hearing aid purchase requests shall be approved initially for one month of rental at $25 per month to determine the appropriateness of the hearing aid; (4) Purchase of the hearing aid may be recommended based on the evaluation of the rental period of paragraph (1). A new authorization form shall be submitted showing the model and serial number of the hearing aid; (5) If the hearing aid purchase is not recommended, a factory reconditioning charge of no more than $50 may be paid when UNOFFICIAL 1737-91 supported by a copy of the manufacturer's invoice; (6) Repair of hearing aids shall be itemized; (7) Hearing aid replacements may be purchased every two years with justification; (8) Ear plugs may be purchased for individuals with recurrent middle ear infections on recommendation by a physician who is an ear, nose and throat specialist. Only one set of ear plugs every twelve months shall be allowed; and (9) Insurance premiums to cover hearing aid losses or repair shall be a coverage only for children under twelve years of age. (d) Eligible children may be referred to the department of health for hearing evaluations and services. [Eff 08/01/94 ] (Auth: HRS §346-14) (Imp: 42 C.F.R. §§431.10, 440.110, 440.220) §17-1737-79 Physical therapy and occupational therapy services. (a) Physical therapy means services prescribed by a physician that are provided to a recipient by a qualified physical therapist licensed by the state and certified by the medicaid program to provide services. Necessary supplies and equipment shall be included as part of this service. (b) Occupational therapy means services prescribed by a physician provided to a recipient by a qualified occupational therapist who has been certified by the American Occupational Therapy Association and approved by the medicaid program to provide services. Necessary supplies and equipment shall be included as part of the service. (c) Physical and occupational therapy may be prescribed by a physician when medically necessary and when the following conditions are met: (1) The services are considered under accepted standards of medical practice, to be a specific and effective treatment for the patient's condition; (2) The services or patient's condition is of a level of complexity requiring services that can be safely and effectively performed only by a qualified therapist. Maintenance therapy which does not require the performance and supervision of a therapist shall be considered as nursing rather than therapy services for separate billing, even if performed or supervised by a therapist; UNOFFICIAL 1737-92 (3) There is an expectation that the patient's condition will improve significantly in a reasonable period of time based on the assessment made by the physician of the patient's restoration potential, or the services are necessary to establish a safe and effective maintenance program required in connection with a specific disease state; and (4) The amount, frequency, and duration of services are reasonable. (d) When physical therapy or occupational therapy is requested for an acute symptomatic condition without demonstrable musculoskeletal abnormality, the therapy shall be provided for only a short period of time not to exceed two weeks, except when extended by prior approval. (e) Where a neuro-musculoskeletal abnormality is demonstrated, a definitive diagnosis shall be made utilizing radiologic or appropriate diagnostic procedures, and if necessary, specialty consultation. (f) All recommended therapy for non-institutional recipients shall require the approval of the medical consultant and the request shall include the following information: (1) Diagnosis; (2) Recommended therapy indicating the frequency and estimated duration of therapy; and (3) For chronic cases, long term goals and a plan of care. (g) Outpatient physical therapy services and outpatient occupational therapy shall be limited to no more than three-fourths of an hour or three modalities of treatment per day although several treatment modalities may be provided during this treatment period. Physical therapy services exceeding three- fourths of an hour or three modalities shall be specifically approved by the department prior to the provision of services. [Eff 08/01/94 ] (Auth: HRS §346-14) (Imp: 42 C.F.R. §§440.10, 440.230)